Ailment that fell Akunyili

A recent report on Nigeria by the Cervical Cancer Free Coalition (CCFC) tagged “crisis card” notes that about 26 Nigerian women die of cervical cancer daily, and with the recent death of a former Information Minister and ex Director-General of NAFDAC, Mrs Dora Akunyili by cervical cancer, Assistant Editor, Investigations, JOKE KUJENYA, examines the prevalence of the ailment in the country.

EACH year, new cases of cervical cancer are diagnosed worldwide. And despite non availability of reliable statistics, Nigeria reportedly has the 10th highest number of deaths from cervical cancer globally.

In January 2014, the Society for Family Health (SFH), reported that cervical cancer killed about 9,659 women in the country. Elaborating on the development, Mr. Bright Ekweremadu, Managing Director, SFH, said most women get Human Papilloma Virus (HPV), infection at least once in 50 years. He said it is only a few of them that develop cervical cancer. According to him, next to breast cancer, cervical cancer, which claims the life of about 9,659 women annually, is the second most frequent cancer among women in Nigeria.

He also noted that about 24.8percent of women in the populace harbour the HPV, the causative virus of cervical cancer in women including genital warts in both men and women.

Experts say that cancer of the cervix, usually caused by HPV, is often transmitted through sexual intercourse. Sadly, it has continued unabated killing women in Nigeria.

On the morning of June 8th, news began to filter across the globe that Mrs. Dora Akunyili, had succumbed to death, after spending four weeks in a Specialist Cancer Hospital, Bangalore, India, where she had gone for treatment, due to cervical cancer. Nigeria stood still.

A few months prior to that, Nigerians were jolted to see a shaggy picture of the once robust Akunyili when she got up to make some comments during a session at the ongoing National Conference in Abuja. However, few days later, she had said “I just need to put on some weight. There is a saying in Igboland that says, let the sickness take the flesh but leave the bones because with time, the bones would grow new flesh. I just came out of major sickness, for which I thank the Almighty God for delivering me. I know that God did that for a purpose, this national conference being part of that purpose. I am well now but only need time to put on more weight. Cancer is indeed a killer disease. Please remember me in your prayers…”

Further reports have it that she had stayed back in the country about 48hours after which she also allegedly succumbed to bouts of coma before she was eventually taken to India for proper treatment.

As the nation mourns the late Mrs Dora Akunyili, considerable number of all women who die of cervical cancer live in just five countries namely: Brazil, Bangladesh, India, China, and Nigeria, in addition to Africa being identified as the most dangerous place to be a woman with cervical cancer.

According to experts, cervical cancer is cancer that forms in the cervix, the lower narrow part of the uterus (womb), often referred to as the neck of the womb, and it is the most common cancer in women under 35. They said that while the main cause remains the HPV virus, early cell changes can be found through screening.

Ekweremadu, speaking at the formal presentation of Cryotherapy Machine for the detection of cancer by SFH in Abuja, also said cervical cancer occurs in midlife and that most cases are found in women younger than 50. He also added that it rarely occurs in women younger than 20 while women over 50 are still at risk.

Prof. Shima Gyoh, Chairman, Board of Trustees, SFH, explained that although cervical cancer was transmitted through sexual intercourse, it usually manifests in women between 40 years and above. He noted that it spreads via uncontrolled growth and spread of abnormal cells in the cervix, the narrow opening of the womb into the vagina. Noting that it has been recognised as the most common female cancer in developing countries with approximately 500,000 new cases and 250,000 deaths occurring each year across the world; experts say a woman dies of cervical cancer every two minutes!

A recent Cervical Cancer Crisis Card launched globally by the Cervical Cancer Free Coalition (CCFC), put the yearly death count from the five top-ranked countries at 137,817, compared to an estimated 275,000 annual total deaths from 500,000 new cases recorded in the 50 countries surveyed in past years. The CCFC Crisis Card rated global countries according to the number of deaths from cervical cancer and the mortality rate from the disease. It states that Nigeria and 49 other countries were selected to provide a snapshot of the world and reflect geographic, economic and population variations.

Also based on 2013 reports from health journals, cervical cancer is the second commonest female cancer worldwide with 529,000 cases and 275, 000 deaths per year with an estimated 25,000 new cases of the ailment making Nigeria to record 480 cases per week, according to a Consultant Obstetrics/Gynaecologist, Usmanu Danfodiyo of the University Teaching Hospital (UDUTH), Sokoto.

Based on a study conducted in Ibadan, aimed at determining the level of cervical cancer awareness in the city, of the total 172 female respondents between ages 15 and 65, a considerable 123 of them representing about 71.5 percent, knew about cervical cancer screening, about 12, 9.8percent had done the Pap smear test, and out of which nine of the 75.0percent have had the disease detected in their bodies.

“The major challenge in Nigeria, as we had in the incidence of HIV/AIDS is that, we, doctors, medical practitioners, are not, in line with the ethics of our discipline, allowed to disclose the status of our patients without their consent. It does not however preclude the alarming fact that scores of Nigeria women daily attend the Lagos University Teaching Hospital (LUTH), and indeed, other teaching hospitals across the country, plus other centres of course, for treatments of cervical cancer. And this particular cancer is dubbed invasive because of its peculiar nature of attacking adjacent tissue; i.e., having or showing a tendency to spread from the point of origin to adjacent tissue, as some other cancers do, said a Consultant Oncologist at the Lagos University Teaching Hospital.

In its diagnoses of cervical cancer, the American Cancer Society estimates that 11,270 were made by the end of 2009 with over 4,000 women in the country dead from the ailment yearly. In UK, over 3,000 women, according to the National Health Service (NHS), were yearly diagnosed with cervical cancer causing 941 of deaths in 2007. Also, the WHO said at least 200,000 women worldwide die of cervical cancer each year. The agency however added that if the HPV vaccine is administered globally, hundreds of thousands of women lives each year could be saved.

And according to the CCFC projections, by 2030, almost half a million women will die of cervical cancer, with over 98 percent of these deaths expected to occur in the developing low and middle- income countries.

Prevalence rates

Health experts say that although the condition is readily detectable in its premalignant stage, cervical cancer remains the second most common cancer in Nigeria and fifth in the United Kingdom (UK). Among the Nigerian female population, it is said to be the most prevalent. In 2007 alone in Nigeria, it was reported that 36.59 million women aged 15-44years were at risk of developing cervical cancer. However, there are 9,922 cases diagnosed annually with 8,030 deaths. HPV prevalence was at 24.8percent as incidence of cervical cancer in Nigeria was at 250 per 100,000 women.

In the outcome of a survey conducted by three professors of health in Ahmadu Bello University (ABU), Zaria, they noted that of the total 260 women administered with questionnaires, the results showed that the respondents displayed fair knowledge of cervical cancer. 43.5percent of the also showed they knew about screening while their knowledge of risk factors was low. About 80.4percent of them also exhibited a generally good attitude to cervical cancer screening. Sadly, their level of practice was 15.4percent poor.

Quoting World Health Organisation (WHO), United Nations (UN), the World Bank and IARC Globocan, the CCFC said the mortality rate and death count highlight the inequity women face depending on where they live showing that the top ten countries with the highest cervical cancer mortality rates are found in Africa with Sub-Saharan Africa grappling with 22 percent of all cervical cancer cases worldwide.

The CCFC in its data shows that more women die of cervical cancer in India, relatively ranked No 1, than other parts of the world. Next is Zambia with 38.6 deaths per 100,000 as the second highest mortality rate. Australia has 1.4 deaths per 100,000 standing as the lowest. Norway ranks 50 recording the least number of deaths. Nigeria on the records, rank 10th having a cervical cancer mortality rate of 22.9 deaths per 100,000.

It is also reported that over fifty percent of cervical cancer diagnoses occur in women from ages 35 to 54, with only a fragment of about 20percent in women over 65years of age. The average age of diagnosis is also said to be 48years even as about 15percent of women develop cervical cancer between the ages of 20 and 30. It is reportedly very rare in women below age 20. However, many young women with early abnormal changes who do not have regular examinations are at high risk for localised cancer by age 40, and for invasive cancer by age 50.

Risk Factors and Causes

knowledge of cervical cancer is considered abysmal among Nigerian women. This factor is similarly responsible for prevalence of precancerous lesions and cervical cancer in South African women. And while it is medically established that HPV is the main risk factor for cervical cancer in women, it is also affirmed that the salient cause sexual interaction with an infected person.

CCFC, Executive Director, Dr. Jennifer Smith, in a report, explained that generally, cancer is often the off shoot of the uncontrolled division of abnormal cells. Most of the cells in the human body have a set lifespan; when they die new cells are produced to replace them. But abnormal cells usually have two problems. One is they don’t die. And secondly, they continue mutating. Then, this result in an excessive accumulation of cells which eventually form a lump also called a tumour. Till date, scientists have not been able to decipher why cells become cancerous. This is why it is vital for people to know the increased risks of developing cervical cancer.

“As it has been medically proven, cervical cancer, in its stages of growth, begins at the neck of the uterus, that is, the womb. It then divides into microscopic cells which can only be viewed through a microscope.”

Symptoms and types

WHILE cervical cancer is easily spoken about, not many are aware of its varying types. It is, however, important to know this so that appropriate treatment could be applied in each presentation of cervical cancer.

A Professor of Oncological Gynaecology at the University of Lagos Teaching Hospital, LUTH, Idi-Araba, Lagos, Dr Rosa, said knowledge and awareness of cervical cancer, a preventable disease, is very low while the toll of ailment on Nigerian women is very high. She thus argued that there is need for cervical cancer in Nigeria and in sub-Saharan to be given the same priority as HIV, malaria, tuberculosis and other forms of communicable diseases. She said it is high time for governments in these regions to be responsive to the wake-up call.

With other health officials, cervical cancer symptoms are given as:

 Bleeding between periods

 Bleeding after sexual intercourse

 Bleeding in post-menopausal women

 Discomfort during sexual intercourse

 Smelly vaginal discharge

 Vaginal discharge tinged with blood

 Pelvic pain and a few others…

The experts said it is important for women to be alert to these warning signs. In fact, during the early stages, those affected may even experience no symptoms at all. It is thus vital again for sexually active women to have habitual cervical smear tests. In all, it is important to recognise cervical cancer as a completely preventable disease.

Prevention and treatment

According to Dr Smith, cervical cancer, no matter how aggressive in the latter stages, is actually a preventable disease. Sadly, so many deaths are recorded across the world.

She noted “It is a disease that can radically be reduced through vaccination, screening and public enlightenment. And to help our women go for screening and vaccination, it is also the collective responsibility of everyone to help them know about the disease, citing Australia’s successful control of the disorder to the country’s successful rollout of a comprehensive package of HPV vaccines, treatment and prevention.

Professor Isaac Adewole, Vice Chancellor of University of Ibadan, a medical doctor said “Early screening methods and prompt treatment are critical interventions that can save women’s lives. What is required of us all is a renewed commitment to saving the lives of our women and preventing a preventable death from the disease.”